Sharing Effective Treatment Information
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Sharing Effective Treatment Information
Effective Addiction Treatment - NYTimes.com
February 4, 2013, 2:17 pm
Effective Addiction Treatment
By JANE E. BRODY
Countless people addicted to drugs, alcohol or both have managed to get clean and stay clean with the help of organizations like Alcoholics Anonymous or the thousands of residential and outpatient clinics devoted to treating addiction.
But if you have failed one or more times to achieve lasting sobriety after rehab, perhaps after spending tens of thousands of dollars, you're not alone. And chances are, it's not your fault.
Of the 23.5 million teenagers and adults addicted to alcohol or drugs, only about 1 in 10 gets treatment, which too often fails to keep them drug-free. Many of these programs fail to use proven methods to deal with the factors that underlie addiction and set off relapse.
According to recent examinations of treatment programs, most are rooted in outdated methods rather than newer approaches shown in scientific studies to be more effective in helping people achieve and maintain addiction-free lives. People typically do more research when shopping for a new car than when seeking treatment for addiction.
A groundbreaking report published last year by the National Center on Addiction and Substance Abuse at Columbia University concluded that "the vast majority of people in need of addiction treatment do not receive anything that approximates evidence-based care." The report added, "Only a small fraction of individuals receive interventions or treatment consistent with scientific knowledge about what works."
The Columbia report found that most addiction treatment providers are not medical professionals and are not equipped with the knowledge, skills or credentials needed to provide the full range of evidence-based services, including medication and psychosocial therapy. The authors suggested that such insufficient care could be considered "a form of medical malpractice."
The failings of many treatment programs - and the comprehensive therapies that have been scientifically validated but remain vastly underused - are described in an eye-opening new book, "Inside Rehab," by Anne M. Fletcher, a science writer whose previous books include the highly acclaimed "Sober for Good."
"There are exceptions, but of the many thousands of treatment programs out there, most use exactly the same kind of treatment you would have received in 1950, not modern scientific approaches," A. Thomas McLellan, co-founder of the Treatment Research Institute in Philadelphia, told Ms. Fletcher.
Ms. Fletcher's book, replete with the experiences of treated addicts, offers myriad suggestions to help patients find addiction treatments with the highest probability of success.
Often, Ms. Fletcher found, low-cost, publicly funded clinics have better-qualified therapists and better outcomes than the high-end residential centers typically used by celebrities like Britney Spears and Lindsay Lohan. Indeed, their revolving-door experiences with treatment helped prompt Ms. Fletcher's exhaustive exploration in the first place.
In an interview, Ms. Fletcher said she wanted to inform consumers "about science-based practices that should form the basis of addiction treatment" and explode some of the myths surrounding it.
One such myth is the belief that most addicts need to go to a rehab center.
"The truth is that most people recover (1) completely on their own, (2) by attending self-help groups, and/or (3) by seeing a counselor or therapist individually," she wrote.
Contrary to the 30-day stint typical of inpatient rehab, "people with serious substance abuse disorders commonly require care for months or even years," she wrote. "The short-term fix mentality partially explains why so many people go back to their old habits."
Dr. Mark Willenbring, a former director of treatment and recovery research at the National Institute for Alcohol Abuse and Alcoholism, said in an interview, "You don't treat a chronic illness for four weeks and then send the patient to a support group. People with a chronic form of addiction need multimodal treatment that is individualized and offered continuously or intermittently for as long as they need it."
Dr. Willenbring now practices in St. Paul, where he is creating a clinic called Alltyr "to serve as a model to demonstrate what comprehensive 21st century treatment should look like."
"While some people are helped by one intensive round of treatment, the majority of addicts continue to need services," Dr. Willenbring said. He cited the case of a 43-year-old woman "who has been in and out of rehab 42 times" because she never got the full range of medical and support services she needed.
Dr. Willenbring is especially distressed about patients who are treated for opioid addiction, then relapse in part because they are not given maintenance therapy with the drug Suboxone.
"We have some pretty good drugs to help people with addiction problems, but doctors don't know how to use them," he said. "The 12-step community doesn't want to use relapse-prevention medication because they view it as a crutch."
Before committing to a treatment program, Ms. Fletcher urges prospective clients or their families to do their homework. The first step, she said, is to get an independent assessment of the need for treatment, as well as the kind of treatment needed, by an expert who is not affiliated with the program you are considering.
Check on the credentials of the program's personnel, who should have "at least a master's degree," Ms. Fletcher said. If the therapist is a physician, he or she should be certified by the American Board of Addiction Medicine.
Does the facility's approach to treatment fit with your beliefs and values? If a 12-step program like A.A. is not right for you, don't choose it just because it's the best known approach.
Meet with the therapist who will treat you and ask what your treatment plan will be. "It should be more than movies, lectures or three-hour classes three times a week," Ms. Fletcher said. "You should be treated by a licensed addiction counselor who will see you one-on-one. Treatment should be individualized. One size does not fit all."
Find out if you will receive therapy for any underlying condition, like depression, or a social problem that could sabotage recovery. The National Institute on Drug Abuse states in its Principles of Drug Addiction Treatment, "To be effective, treatment must address the individual's drug abuse and any associated medical, psychological, social, vocational, and legal problems."
Look for programs using research-validated techniques, like cognitive behavioral therapy, which helps addicts recognize what prompts them to use drugs or alcohol, and learn to redirect their thoughts and reactions away from the abused substance.
Other validated treatment methods include Community Reinforcement and Family Training, or Craft, an approach developed by Robert J. Meyers and described in his book, "Get Your Loved One Sober," with co-author Brenda L. Wolfe. It helps addicts adopt a lifestyle more rewarding than one filled with drugs and alcohol.
This is the first of two articles on addiction treatment.
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February 4, 2013, 2:17 pm
Effective Addiction Treatment
By JANE E. BRODY
Countless people addicted to drugs, alcohol or both have managed to get clean and stay clean with the help of organizations like Alcoholics Anonymous or the thousands of residential and outpatient clinics devoted to treating addiction.
But if you have failed one or more times to achieve lasting sobriety after rehab, perhaps after spending tens of thousands of dollars, you're not alone. And chances are, it's not your fault.
Of the 23.5 million teenagers and adults addicted to alcohol or drugs, only about 1 in 10 gets treatment, which too often fails to keep them drug-free. Many of these programs fail to use proven methods to deal with the factors that underlie addiction and set off relapse.
According to recent examinations of treatment programs, most are rooted in outdated methods rather than newer approaches shown in scientific studies to be more effective in helping people achieve and maintain addiction-free lives. People typically do more research when shopping for a new car than when seeking treatment for addiction.
A groundbreaking report published last year by the National Center on Addiction and Substance Abuse at Columbia University concluded that "the vast majority of people in need of addiction treatment do not receive anything that approximates evidence-based care." The report added, "Only a small fraction of individuals receive interventions or treatment consistent with scientific knowledge about what works."
The Columbia report found that most addiction treatment providers are not medical professionals and are not equipped with the knowledge, skills or credentials needed to provide the full range of evidence-based services, including medication and psychosocial therapy. The authors suggested that such insufficient care could be considered "a form of medical malpractice."
The failings of many treatment programs - and the comprehensive therapies that have been scientifically validated but remain vastly underused - are described in an eye-opening new book, "Inside Rehab," by Anne M. Fletcher, a science writer whose previous books include the highly acclaimed "Sober for Good."
"There are exceptions, but of the many thousands of treatment programs out there, most use exactly the same kind of treatment you would have received in 1950, not modern scientific approaches," A. Thomas McLellan, co-founder of the Treatment Research Institute in Philadelphia, told Ms. Fletcher.
Ms. Fletcher's book, replete with the experiences of treated addicts, offers myriad suggestions to help patients find addiction treatments with the highest probability of success.
Often, Ms. Fletcher found, low-cost, publicly funded clinics have better-qualified therapists and better outcomes than the high-end residential centers typically used by celebrities like Britney Spears and Lindsay Lohan. Indeed, their revolving-door experiences with treatment helped prompt Ms. Fletcher's exhaustive exploration in the first place.
In an interview, Ms. Fletcher said she wanted to inform consumers "about science-based practices that should form the basis of addiction treatment" and explode some of the myths surrounding it.
One such myth is the belief that most addicts need to go to a rehab center.
"The truth is that most people recover (1) completely on their own, (2) by attending self-help groups, and/or (3) by seeing a counselor or therapist individually," she wrote.
Contrary to the 30-day stint typical of inpatient rehab, "people with serious substance abuse disorders commonly require care for months or even years," she wrote. "The short-term fix mentality partially explains why so many people go back to their old habits."
Dr. Mark Willenbring, a former director of treatment and recovery research at the National Institute for Alcohol Abuse and Alcoholism, said in an interview, "You don't treat a chronic illness for four weeks and then send the patient to a support group. People with a chronic form of addiction need multimodal treatment that is individualized and offered continuously or intermittently for as long as they need it."
Dr. Willenbring now practices in St. Paul, where he is creating a clinic called Alltyr "to serve as a model to demonstrate what comprehensive 21st century treatment should look like."
"While some people are helped by one intensive round of treatment, the majority of addicts continue to need services," Dr. Willenbring said. He cited the case of a 43-year-old woman "who has been in and out of rehab 42 times" because she never got the full range of medical and support services she needed.
Dr. Willenbring is especially distressed about patients who are treated for opioid addiction, then relapse in part because they are not given maintenance therapy with the drug Suboxone.
"We have some pretty good drugs to help people with addiction problems, but doctors don't know how to use them," he said. "The 12-step community doesn't want to use relapse-prevention medication because they view it as a crutch."
Before committing to a treatment program, Ms. Fletcher urges prospective clients or their families to do their homework. The first step, she said, is to get an independent assessment of the need for treatment, as well as the kind of treatment needed, by an expert who is not affiliated with the program you are considering.
Check on the credentials of the program's personnel, who should have "at least a master's degree," Ms. Fletcher said. If the therapist is a physician, he or she should be certified by the American Board of Addiction Medicine.
Does the facility's approach to treatment fit with your beliefs and values? If a 12-step program like A.A. is not right for you, don't choose it just because it's the best known approach.
Meet with the therapist who will treat you and ask what your treatment plan will be. "It should be more than movies, lectures or three-hour classes three times a week," Ms. Fletcher said. "You should be treated by a licensed addiction counselor who will see you one-on-one. Treatment should be individualized. One size does not fit all."
Find out if you will receive therapy for any underlying condition, like depression, or a social problem that could sabotage recovery. The National Institute on Drug Abuse states in its Principles of Drug Addiction Treatment, "To be effective, treatment must address the individual's drug abuse and any associated medical, psychological, social, vocational, and legal problems."
Look for programs using research-validated techniques, like cognitive behavioral therapy, which helps addicts recognize what prompts them to use drugs or alcohol, and learn to redirect their thoughts and reactions away from the abused substance.
Other validated treatment methods include Community Reinforcement and Family Training, or Craft, an approach developed by Robert J. Meyers and described in his book, "Get Your Loved One Sober," with co-author Brenda L. Wolfe. It helps addicts adopt a lifestyle more rewarding than one filled with drugs and alcohol.
This is the first of two articles on addiction treatment.
Copyright 2013 The New York Times CompanyPrivacy PolicyNYTimes.com 620 Eighth Avenue New York, NY 10018Register at NYTimes.comClose.
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Member
Join Date: May 2012
Posts: 1,927
Thank you for sharing this... really good information here & it all matches up with the shift that is occurring in the medical community & also govt sponsored organizations.
Personally, I think "individualized treatment" is the key to controlling/ending addiction. My husband went through 3 months of rehab (non 12 step) with focus on intensive individual therapy. They keyed in on what he needed. Just like in that article (as they recommended) I (as family) spent a lot of time reseraching treatment methods when he was actively using - because I wanted to have the knowledge if/when he needed to seek professional help. Not saying everyone needs rehab; but for my husband, the type of treatment he received was right for him; it was a blessing. He was ready to soak it all in, I will admit that. But he learned so much and is doing really well. It was the first attempt at treatment for him. He's been clean 10 months & is going strong.
I think anyone who has a loved one... and they have been unsuccessful in the same mode of treatment over and over... should look at alternatives. Its crazy to me ...doing the same thing over and over ... and expecting different results.
"Substance abuse treatment refers to a broad range of activities or services, including identification of the problem (and engaging the individual in treatment); brief interventions; assessment of substance abuse and related problems including histories of various types of abuse; diagnosis of the problem(s); and treatment planning, including counseling, medical services, psychiatric services, psychological services, social services and follow-up for persons with alcohol or other drug problems" (Institute of Medicine)
Substance abuse treatment may be based on one of several traditional approaches:
the Medical Model which focuses on the recognition of addiction as a bio/psycho/social disease, the need for life-long abstinence, and the use of an ongoing recovery program to maintain abstinence;
the Social Model which focuses more on the need for long-term abstinence and the need for self-help recovery groups to maintain sobriety;
the Behavioral Model which focuses more on diagnosis and treatment of other problems or conditions that can interfere with recovery (Health Human Services / Substance Abuse Mental Health Services Administration)
Many programs use a combination of some aspects of the various models in order to facilitate the most appropriate treatment for the individual and to give patients options.
Treatment may occur in various settings, such as inpatient, hospital-based programs; short- and long-term residential programs; or outpatient programs; and may be augmented by self-help/12-step and other support groups.
Treatment may also use a combination of therapies, such as pharmacological therapy to treat certain addictions (for example the use of methadone for heroin addiction or the use of antabuse to treat alcoholism); use of psychological therapy or counseling, education and social learning theories; and non-traditional healing methods such as acupuncture.
Treatment may extend over the course of weeks, months, or years, depending on the severity of the problems and the level of burden created by clients' multiple disorders such as alcoholism, other drug addiction, HIV/AIDS, mental illness (especially depression), and serious physical illnesses. The type and intensity of treatment depend on the patient's psychological, physical, and social problems; the stage (or severity) and type of addiction; personality traits; and social skills before the onset of addiction "(HHS/SAMHSA)
Personally, I think "individualized treatment" is the key to controlling/ending addiction. My husband went through 3 months of rehab (non 12 step) with focus on intensive individual therapy. They keyed in on what he needed. Just like in that article (as they recommended) I (as family) spent a lot of time reseraching treatment methods when he was actively using - because I wanted to have the knowledge if/when he needed to seek professional help. Not saying everyone needs rehab; but for my husband, the type of treatment he received was right for him; it was a blessing. He was ready to soak it all in, I will admit that. But he learned so much and is doing really well. It was the first attempt at treatment for him. He's been clean 10 months & is going strong.
I think anyone who has a loved one... and they have been unsuccessful in the same mode of treatment over and over... should look at alternatives. Its crazy to me ...doing the same thing over and over ... and expecting different results.
"Substance abuse treatment refers to a broad range of activities or services, including identification of the problem (and engaging the individual in treatment); brief interventions; assessment of substance abuse and related problems including histories of various types of abuse; diagnosis of the problem(s); and treatment planning, including counseling, medical services, psychiatric services, psychological services, social services and follow-up for persons with alcohol or other drug problems" (Institute of Medicine)
Substance abuse treatment may be based on one of several traditional approaches:
the Medical Model which focuses on the recognition of addiction as a bio/psycho/social disease, the need for life-long abstinence, and the use of an ongoing recovery program to maintain abstinence;
the Social Model which focuses more on the need for long-term abstinence and the need for self-help recovery groups to maintain sobriety;
the Behavioral Model which focuses more on diagnosis and treatment of other problems or conditions that can interfere with recovery (Health Human Services / Substance Abuse Mental Health Services Administration)
Many programs use a combination of some aspects of the various models in order to facilitate the most appropriate treatment for the individual and to give patients options.
Treatment may occur in various settings, such as inpatient, hospital-based programs; short- and long-term residential programs; or outpatient programs; and may be augmented by self-help/12-step and other support groups.
Treatment may also use a combination of therapies, such as pharmacological therapy to treat certain addictions (for example the use of methadone for heroin addiction or the use of antabuse to treat alcoholism); use of psychological therapy or counseling, education and social learning theories; and non-traditional healing methods such as acupuncture.
Treatment may extend over the course of weeks, months, or years, depending on the severity of the problems and the level of burden created by clients' multiple disorders such as alcoholism, other drug addiction, HIV/AIDS, mental illness (especially depression), and serious physical illnesses. The type and intensity of treatment depend on the patient's psychological, physical, and social problems; the stage (or severity) and type of addiction; personality traits; and social skills before the onset of addiction "(HHS/SAMHSA)
Member
Join Date: Nov 2012
Posts: 1,618
This is why I like the Salvation Army. They do all of these things, they are free, and allow thier beneficiaries to stay as long as needed. they don't boot them out the door at 6 months. many times people will choose to stay for 9 months or more, and after 6 months they are required to get a job on the outside and pay rent.
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